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From YouTube: 2/15/2021 - Senate Committee on Commerce and Labor
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A
Good
morning,
everyone
we'll
call
this
meeting
of
the
senate
committee
on
commerce
and
labor
to
order
like
to
welcome
everyone
who
is
visiting
us
online.
I
want
to
say
we
got
a
couple
of
housekeeping
things
that
we
need
to
take
care
of.
So
I
want
to
make
sure
that
we
do
that
before
we
do
that
secretary.
A
Please
I
hear
present
as
soon
as
they
arrive
welcome
to
all
of
you
who
are
joining
us
remotely
and
anyone
else
who
is
listening
over
the
internet.
Today
we
have
a
hearing
on
senate
bill,
56.
A
some
housekeeping
items.
I
would
take
a
moment
to
go
over
some
of
these.
As
you
know,
the
building
is
currently
closed
as
a
public
safety
measure
to
reduce
the
spread
and
infection
rate
of
covet
19,
and
so
all
committees
will
be
virtually
meaning
committee
members
staff
and
everyone
else
will
participate
either
through
zoom
conference
or
by
telephone.
A
A
Members
of
the
public
must
first
register
for
the
meeting
you
would
like
to
participate
in
committee
meetings
are
listed
in
several
places
on
nellis
and
to
register
simply
click
the
participate
button
near
the
meeting
date
and
time
then
fill
in
the
required
information,
such
as
your
name,
the
agenda
item
and
what
you're
interested
in
once
your
registration
is
submitted.
You
will
see
a
confirmation
screen
and
you
will
also
receive
an
email
with
the
phone
number
and
meeting
id
to
call
at
the
time
of
the
meeting.
A
Just
a
note
that,
while
we're
meeting
while
we're
meeting
registration
is
required
to
participate,
it
does
not
guarantee
that
you
will
be
able
to
speak
similar
to
provisions
in
sessions.
Comments
and
public
comment
may
be
limited
due
to
time
constraints.
I
will
announce
the
time
frame
how
many
minutes
we
have
for
each
response
for
against
or
neutral.
A
A
When
someone
has
already
covered
your
points,
this
will
allow
more
time
for
people
to
comment
during
the
time
frame
you're
on
the
phone
line.
Please
pay
attention
to
which
bill
is
being
cut
considered
and
follow.
The
verbal
prompts
provided
by
bps
staff
do
this
so
that
you
know
which
keys
to
press
to
raise
your
hand
or
unmute
yourself.
A
A
If
you
need
assistance
with
any
of
these
with
any
of
these
processes
or
if
you
would
like
to
receive
electronic
notification
of
a
committee's
agenda
and
the
minutes,
please
contact
our
committee
manager
at
the
committee
email
listed
on
the
agenda.
Any
exhibits
for
the
committee
must
be
submitted
in
electronic
format.
No
later
than
eight
o'clock
am
the
day
before
the
meeting
to
our
committee
manager,
terry
miller,
or
our
committee
policy
analyst
cesar
melore,
ho
committee
contact
information
may
be
found
on
the
committee
page
in
nellis.
A
I
will
not
entertain
any
amendments
if
the
bill
sponsor
is
not
aware
of
the
amendment.
The
proposed
amendment
must
be
submitted
in
writing.
24
hours
prior
to
the
meeting,
please
include
the
bill
number,
a
statement
of
intent
and
your
contact
information
and
when
testifying,
please
turn
turn
or
unmute
your
microphone
and
clearly
state
your
name
and
what
you're
going
to
talk
about,
speak
clearly
and
project
your
voice.
A
A
A
The
chair
and
members
of
members
may
request
any
testifier
to
submit
documentation
supporting
their
testimony
to
committee
members.
During
these
virtual
meetings,
when
an
agenda
item
is
called
for
a
vote,
our
committee
will
be
using
roll
call
to
do
so
when
the
secretary
calls
your
name,
please
answer
with
a
yes
or
no,
so
that
there
is
no
confusion.
A
A
D
D
I
am
the
chair
of
the
clark
regional
behavioral
health
policy
board.
I'd
like
to
start
by
thanking
you
for
allowing
us
to
present
sp
for
tuesday
in
march
of
2020.
All
of
us
were
thrust
into
a
new
reality
and
at
times
it
felt
like
all
the
rules
were
thrown
out
the
window.
In
some
cases
this
was
accurate.
For
example,
the
rules
around
telehealth,
all
of
us
had
to
adjust
to
new
ways
of
living
and
working
consumers
suddenly
found
themselves
disconnected
from
their
mental
health
professionals.
A
On
just
a
minute
sure,
I'm
not
sure
if
this
is
happening
to
the
other
committee
members,
but
it's
it's
just
a
little
bit
muffled
and
I
want
to
make
sure
we
get
all
of
the
information
you
need
to
present
to
us.
D
C
C
E
E
E
D
D
D
The
pandemic
has
been
very
difficult
for
all
of
us,
but
the
difficulties
of
this
new
reality
have
also
taught
us
some
lessons
along
the
way.
The
clark
board
felt
strongly
enough
that
behavioral
health
telehealth
was
one
of
the
lessons
that
we
have
learned
during
the
pandemic.
That
needs
to
be
continued.
D
D
There
are
a
variety
of
reasons
that
consumers
cannot
or
do
not
access,
services,
barriers
to
care,
are
oftentimes
transportation,
time
constraints
and
competing
life
priority,
and
those
are
only
just
a
few
of
the
potential
reasons
in
the
fiscal
note
that
was
submitted
by
medicaid.
It
states
that
it
is
anticipated
that
this
provision
will
increase
utilization
of
behavioral
health
telehealth
services
by
approximately
10
percent.
D
D
I
want
to
also
briefly
touch
on
the
idea
of
payment
parity.
The
behavioral
health
services
provided
by
telehealth
are
the
same
as
those
provided
in
person.
The
behavioral
health
policy
board
felt
that
this
was
an
important
step.
Take
to
break
down
some
of
the
barriers
previously
mentioned,
understanding
that
some
may
prefer
to
attend
in
person
after
things
go
back
to
the
new
normal
others
will
not
will
not
whether
due
to
barriers
or
choice
providing
payment
parity
helps
ensure
that
consumers
have
choice
without
negatively
affecting
providers
and
their
ability
to
cover
their
own
costs.
G
Get
really
close
too.
Dr
dixon
is
also
a
member
of
the
clark
regional
behavioral
health
policy
board.
She
sends
her
regrets
for
not
being
able
to
join
you
today.
G
Npa
strongly
supports
sb
56
and
they
have
submitted
written
testimony.
In
addition
to
these
remarks,
as
mentioned
by
miss
frost,
the
foundation
for
this
bill
was
a
paper
prepared
by
the
american
psychiatric
association
in
2020
entitled
support
for
permanent
expansion
of
telehealth
regulations.
After
covid19,
a
copy
has
been
emailed
to
the
committee
members.
G
The
advantage
of
these
decisions
were
significant
and
provided
the
opportunity
for
care
to
continue.
Despite
the
challenging
times,
dr
jeffrey
geller,
president
of
the
american
psychiatric
association,
testified
before
congress
in
june
of
last
year.
Regarding
the
importance
of
telehealth,
he
stated
that
quote
the
lifting
of
geographic
and
site
of
service
restrictions,
including
allowing
the
patient
to
be
seen
in
the
home
and
the
use
of
audio
only
for
telehealth
when
a
patient
lacks
the
technology
or
bandwidth
for
video,
have
enabled
large
numbers
of
patients,
including
vulnerable
populations,
to
receive
care.
G
G
We
submit
to
you
that
one
of
these
is
similar
to
the
experience
that
the
legislature
has
had
allowing
for
opportunity
to
provide
testimony
remotely
has
created
another
avenue
for
public
participation
in
the
process.
Likewise,
enhancing
options
to
patients
increases
the
opportunities
for
the
delivery
of
care.
G
G
G
Our
state
continues
to
rank
51st
according
to
the
2020
mental
health
america
report,
which
measures
overall
prevalence
of
mental
health
issues
and
access
to
care,
as
proposed
in
sb
56,
ensuring
payment
parity
for
the
delivery
of
mental
health
services,
including
audio,
only
will
allow
nevada
to
provide
one
more
access
point
to
mental
health
care.
The
nevada
psychiatric
association
strongly
encourages
your
support
of
sb
56.
H
S-S-C-O-T,
I'm
testifying
on
my
personal
experience
last
february.
I
was
really
sick.
I
live
alone
on
the
third
floor
of
an
apartment,
building
with
only
stairs
my
family
had
health
challenges,
so
couldn't
come
up
the
stairs
and
I
ended
up
in
urgent
care
three
times
in
five
days,
because
I
couldn't
breathe
due
to
the
medications
I
was
put
on.
My
immunity
was
impacted
and
I
was
stuck
at
home
recovering
for
weeks.
H
I
couldn't
get
anywhere.
My
only
lifeline
was
my
therapy.
We
met
through
zoom
style
meetings
once
a
week
and
at
times
my
internet
wasn't
stable
enough.
So
we
talked
on
the
phone.
I
cannot
stress
enough
how
much
those
calls
and
telemeetings
meant
to
me.
I
spent
months
at
home
and
isolated
from
everyone
and
became
very
depressed.
H
We
call
and
zoom
with
people
who
are
having
emotional
challenges
or
have
mental
illnesses
through
the
support
we
provide,
we
try
to
do
some
zoom
meetings,
and
yet
we
are
unable
to
in
rural
areas
due
to
the
reception
internet
issues,
so
we
rely
on
the
phone,
although
I
personally
prefer
zoom
meetings.
I
have
come
to
learn
how
important
the
possibility
of
phone
therapy
can
be
and
strongly
support,
having
both
options
available
to
people
when
zoom
isn't
available,
it
can
mean
the
world
to
have
those
phone
calls.
Thank
you.
D
Spearman
shar
frost
for
the
record.
That
concludes
our
presentation
and
we
are
available
for
questions.
If
the
committee
has
any.
A
Thank
you,
ms
frost,
I'll,
open
up
to
questions
from
committee
members.
I
see
senator
pickert
and
senator
settlemyer
senator
picker.
I
Thank
you,
madam
chair,
and
I
apologize
for
not
getting
the
right
login
information
in
a
timely
fashion.
My
question
is
well.
I
have
two
quick
questions.
First,
I
I
just
want
to
say
I
am
in
complete
support
of
increasing
access
to
behavioral
health
services
in
nevada.
We've
got
to
get
our
last
place
in
that
instance,
where
we're
so
far
behind
that
anything
that
provides
more
access,
I
think,
is
probably
going
to
be
a
good
thing.
I
just
want
to
clarify
one
point
and
then
ask
a
question.
I
I
It's
my
understanding
that
the
intent
of
this
bill
is
not
to
require
all
policies
to
provide
coverage
for
behavioral
health
services,
but
those
that
do
those
policies
that
do
provide
for
coverage
have
to
provide
for
and
allow
for
telehealth
to
the
same
extent
that
they
provide
inpatient
or
or
in
person
rather
coverage
is.
Is
that
a
correct
understanding
or
is
the
intent
of
the
bill
to
require
every
health
insurance
policy
to
cover
behavioral.
D
So,
thank
you
care
spearmen
through
you
to
senator
pickard.
Thank
you
for
the
question.
This
is
a
yes,
you
are
correct
this.
This
is
not
about
requiring
insurance
companies
to
cover
behavioral
health.
There
are
federal
mandates
in
place
regarding
parity,
most
notably
the
mental
health
parity
act,
but
for
those
those
insurance
policies
that
do
cover
behavioral
health,
we
just
want
consumers
to
have
the
ability
to
attend
their
their
provider
services
or
their
appointments
in
a
way
that
makes
sense
for
them,
regardless
of
the
reason
they're
unable
to
in.
D
E
D
That
is
correct
if
a
if
a
consumer
would
like
to
receive
telehealth
services
and
they're
certainly
welcome
to
find
a
provider
who
provides
those
kinds
of
services,
but
there's
no
requirement
for
the
provider
to
provide
those
services
via
telehealth
if
they're
not
comfortable
with
it.
So
I
think
it
really
provides
choice
on
both
sides
of
the
coin.
E
E
It's
not
the
same
as
being
in
person
and
having
a
psychiatrist
be
able
to
watch
the
actions,
the
interaction
between
let's
say
couples
or
the
concept
of
watching
how
somebody
fidgets,
you
know
they
can't
read
them:
they're,
not
able
to
do
their
full
training
as
well
through
this
media
as
they
are
in
person.
This
is
not
the
same
thing.
It's
just
like
this
building
we're
not
obtaining
the
same
quality
legislation,
in
my
opinion,
as
if
we
actually
had
the
ability
to
interact
with
you
in
the
traditional
sense.
E
So
will
there
be
some
ability,
or
can
we
create
some
type
of
a
bonus
or
something
for
people
that
actually
go
forward
in
a
traditional
fashion,
because
obviously
they
have
higher
expenses?
They
have
an
actual
brick
and
mortar
institution.
You
know
they
have
their
building
that
they
have
to
have
office
hours
at
and
they'll
have
to
have
cleaning
of
those
supplies,
or
rather
the
seats.
The
chairs.
You
know
the
pins
and
things
of
that
nature
and
they're
going
to
have
higher
expenses
than
just
a
tele
health
situation.
E
So
I
appreciate
the
concept
of
opening
up
more,
but
then
how
do
we
make
sure
that
those
individuals
that
are
doing
the
traditional,
which
I
think
is
more
effective
of
in
person?
It
requires
a
further
commitment
of
individuals.
Now
some
people
can't
make
it
and
I
get
that.
But
what
can
we
do
to
still
promote
the
traditional
system.
D
Thank
you
for
the
question
sharp
frost
for
the
record,
chair
spearmint
through
you
to
senator
settlemyre.
I
think
that
was
a
large
part
of
the
discussions
that
we
had
on
the
board.
It's
important
that
we
do
understand
that
sometimes
it
is
preferable
to
visit
a
provider
in
person.
D
What
we're
seeing
is
that
telehealth
is
paid
at
a
lesser
rate
and
if
especially
in
some
of
our
frontier
communities
and
our
rural
communities,
it
was
a
very
robust
discussion
about
the
needs
of
those
communities.
D
When
you're
200
miles
away
from
the
nearest
provider,
we'd
be
paying
that
same
provider
less
for
a
telehealth
service,
while
they
are
still
providing
in-person
services
as
well,
and
so
that's
where
we
landed
on
this
in
making
sure
that
we
are
protecting
everyone
and
although
it
is
not
always
preferable
to
have
services
provided
by
telehealth
or
telephonically,
sometimes,
unfortunately,
it's
better
than
nothing,
especially
when
there
are
barriers
to
being
able
to
provide
that
service
in
person.
E
I
appreciate
that,
and
I
agree
with
you
it's
absolutely
better
than
nothing
and
it
is
tremendously
allowed
further
outreach,
especially
into
more
rural
areas
or
for
individuals
that,
through
their
conditions,
cannot
make
it.
You
know
some
people
just
you
know
they
don't
want
to
get
out
of
their
house
and
it's
kind
of
understandable
with
what's
going
on,
but
in
the
same
respect,
do
you
not
agree
that
in
person
is
better
than
tella
when
possible?
E
And
so
I
guess
that's
what
I'm
trying
to.
I
want
to
agree
with
you
to
give
everybody
the
same
rate
that's
going
on
now,
but
then
we
also
give
a
bonus
to
those
individuals
that
are
still
keeping
a
brick
and
mortar
institution
going.
I
guess
that's
my
question
to
you.
Don't
you
agree
that
it's
better
to
do
in
person,
rather
than
tell
her
all
the
time.
D
Sir
frost
for
the
record
senator
spearman
through
you
to
senator
settlemyre,
I'm
direct
go
direct.
Thank
you,
chair
spearman,
for
the
record.
I
am
a
consumer
and
a
parent
of
consumers.
I
cannot,
I
probably
am
not
the
right
person
to
comment
on
the
efficacy
of
in-person
versus
telehealth,
so
I
can't
answer
that
question.
Hopefully
there
will
be
or
possibly
miss
cartwright
might
be
able
to
answer
that
on
behalf
of
the
psychiatric
association,
but
I'm
probably
not
the
right
person
to
answer
that
particular
question
and
I
personally
prefer
telehealth
services.
D
D
Sometimes
the
office
can
seem
very
intimidating
and,
although
I
do
foresee
a
time
where
I
will
probably
you
know
be,
you
know,
my
therapist
will
probably
want
to
see
me
every
at
least
every
now
and
again.
I
fully
suspect
that
I
will
continue
utilizing
telehealth
services
to
support
my
own
mental
health
state
and
my
and
my
my
sons
as
well.
G
I'm
happy
to
jump
in
with
additional
explanation
if
needed.
Sorry
leah
case
for
the
record,
formerly
cartwright,
miss
frost.
G
If
you
look
on
nellis,
there
should
be
two
exhibits,
one
from
dr
dixon
and
one
from
dr
elliott
cole.
Both
of
these
are
practicing
physicians,
psychiatrists
here
in
nevada,
and
they
talk
about
their
experience
with
telehealth,
including
the
telephone
and,
while
in
person
may
be
beneficial
for
some
clients.
G
E
I
appreciate
that
leah.
I
guess
where
I'm
at
is
I'm
not
trying
to
argue
that
this
isn't
a
valuable
tool
and
not
a
fundamentally
a
fantastic
tool?
It's
just
a
question
assuming
we
try
to
create
some
benefit
so
that
individuals
get
paid
slightly
more
for
actually
having
a
brick
and
mortar
institution,
but
I
won't
break
that
any
further,
because,
again,
I'm
very
supportive
of
the
bill.
I
am
curious,
though,
will
this
allow,
then
telehealth
will
be
accepted
for
workers
comp
claims
pursuant
to
616
c
0.180
for
behavioral
health
correct
well.
E
D
A
Thank
you.
I
see
vice
chair
neil
and
then
senator.
F
Scheible,
thank
you.
Jr
spearman.
I
believe
senator
lange
asked
the
question
too.
So
I
I
have
a
couple
questions
so
on.
Well,
there's
some
language
on
section
one
and
section
four,
so
I'm
gonna
take
this
one
question
together,
because
this
language
shows
up
multiple
times.
So,
if
you
look
at
I'll,
just
highlight
you
to
section
four.
F
So
if
you
go
to
section
four
lines,
ten
through
fourteen,
basically,
the
language
that
keeps
showing
up
is
saying
that
a
provider
a
benefit
contract
of
behavioral
health
services
that
they
that
they
must
that
they
cannot
basically
tell
them
to
include,
but
that
they
may
provide
a
prior
authorization,
I'm
confused
about
the
language
actually,
because
I
don't
understand
why
it
says
you,
you
must
not
do
it
and
you
may,
at
the
back
end
of
the
paragraph.
F
D
Frost
for
the
record,
senator
neil,
the
sub
4
or
section
4
sub
3.
F
Yeah
a
benefit
contract
must
not
require
an
insurer
to
obtain
prior
authorization
for
any
behavioral
health
service,
but
then
the
the
bottom
paragraph
and
says,
but
a
benefit
contract-
may
require
prior
authorization
for
behavioral
health.
So
talk
to
me
about
that
language,
it
shows
up
several
times
in
different
sections.
F
D
Thanks
to
me,
thank
you
for
the
question
senator
neil
sharp
frost
for
the
record.
So
essentially
what
it's
saying
in
that
section
is
that
that,
if
you
don't,
if
the,
if
the
payer
does
not
require
prior
authorization
for
behavioral
health
services,
normally
in
person,
then
they
they
may
not
require
it
for
telehealth
services.
D
However,
if
they
do
require
prior
authorization
for
behavioral
health
services
normally,
then
they
may
also
require
it
for
telehealth
services.
So
it's
that
that
issue
of
does
the
pair
normally
require
prior
off.
If
they
do,
then
they
may
also
require
that
for
telehealth,
but
if
they
do
not,
they
may
not
require
it
for
telehealth.
Does
that
clarify
that
at.
F
D
It
depends
on
the
payer,
it
depends
on
the
insurance
company
to
be
quite
honest:
okay,
okay!
Well,
for
medicaid,
there
is
a
prior
op,
but
it's
not
required
until
after
a
certain
amount
of
of
appointment
and
then
after
as
they
continue
on
and
the
longevity
of
the
services,
and
it
determines
that.
F
F
I
know
you're
trying
to
go
across
the
board,
but
right
now
aren't
there
regional
confines
to
how
behavioral
health
services
work.
So
we
have
essential
health
care
providers
who
may
focus
in
north
las
vegas
or
who
may
focus
in
like
underserved
areas.
Only.
D
Senator
neil,
thank
you
for
the
question.
I'm
just
trying
to
find
the
section
so
section.
Six,
I'm
sorry!
It
wasn't.
D
So
I
this
this
piece
when
we
start
talking
about
geographic
location,
there
has
there
has
been
some
discussion
where
certain
certain
people,
certain
consumers,
were
not
able
to
receive
this
type
of
service
because
they
happen
to
live
in
an
urban
environment
where
there
is
some
some
equity
issues
between
not
being
able
to
receive
a
service
based
on
the
fact
that
you
lived
in
north
las
vegas
or
reno
versus
living
in
the
rurals
or
living
in
the
frontier.
So
we
wanted
to.
D
J
Thank
you,
chair
spearman,
for
the
record.
Will
keen
committee
council
on
some
of
the
questions
that
have
just
come
up
as
far
as
the
section
four
that
was
just
being
discussed?
J
J
Subsection
4
does
not
authorize
someone
to
provide
care,
they
would
not
otherwise
be
authorized
to
provide.
So
if
you
had
somebody
who
was
somehow
limited
in
scope
and
what
care
they
could
provide,
they
could
not
provide
that
care
through
telehealth
in
a
manner
they
wouldn't
be
able
to
provide
in
person
and
just
quickly
on
a
couple
of
other
points
that
came
up.
J
I
completely
agree
with
miss
frost
on
subsection
three
that
the
goal
of
subsection
three
is
simply
to
make
sure
that
prior
authorization
is
not
imposed
on
telehealth
or
standard
telephone
use
unless
it's
universally
imposed.
So
if
a
policy
already
requires
that
you
have
prior
authorization
before
getting
this
kind
of
service,
then
you
have
to
get
the
prior
authorization
if
you're
going
to
get
it
through
telehealth
or
standard
telephone
and
earlier
there
was
also
a
question
about
workers,
comp
coverage
and
that
is
provided
in
section
nine
section.
J
F
So
chair
just
one
last
question,
then
I'm
done
okay.
So
so
I
have
like
the
printed
copy.
So
I'll
just
say:
I'm
on
a
mine
is
section
it's
age
15,
but
it's
section
8.-
and
this
is
the
language
about.
If
the
state
plan
for
medicaid
includes
a
requirement
that
the
state
and
to
the
extent
practicable
or
any
political
subdivision,
the
non-federal
share
language,
miss
miss
frost.
Do
you
see
where
I'm
at.
D
Refresh
for
the
record
senator
neil,
yes,
I
do.
F
D
Shar
frost
for
the
record.
Thank
you
for
the
question,
senator
neal.
To
be
honest,
I
am
also
I
am
not
a
medicaid
expert.
D
F
A
Thank
you,
and
I
think
mr
megareijo
is
contacting
somebody
now
from
dhhs
senator
lang.
I
did
not
see
your
hand
so
go
next
and
hold
on.
We
have
mr
young,
you
want
to
answer
the
question.
K
Good
morning,
chairman
spearman,
we
will
provide
testimony
a
bit
later
on
some
of
the
other
issues,
but
to
answer
the
question
chair
that
senator
neil
posed
is
that
medicaid
does
not
set
its
rates
different
geographically
and
nrs.
422
already
demands
pay
parity
from
traditional
telehealth
and
in-person
services.
A
Okay,
senator
lange.
Thank
you,
chair
spearman
and
I
see
senator
hardy's
hand.
F
F
My
question
has
to
do
with
children,
so
under
this
telehealth
bill
would
children
be
included
in
that
because
I
know
off
in
many
instances
it's
more
beneficial
for
children
to
go
to
a
therapist
or
a
counselor
in
person
just
for
some
of
the
reasons
that
senator
settlemyre
said
and
they
have
manipulatives
and
different
kinds
and
their
emotions
and
their
actions
tell
a
story
as
well.
So
I'm
just
curious
if
this
would
just
deal
with
adults
or
it
also
includes
children.
D
Our
frost
for
the
record,
thank
you,
senator
lange
for
the
question
this
does
not
this
is
this
would
include
children
and
those
decisions
would
be
left
up
to
the
provider
and
the
parent
to
decide
what
is
the
best
way
to
and
the
most
effective
way
to
provide
the
services
to
the
to
the
child
or
youth.
F
Say,
thank
you.
I
think
I
know
people
that
have
used
this
and
it's
been
really
beneficial
to
them.
A
Thank
you,
senator
schreiber.
L
Thank
you,
spearman.
L
I
have
two
kind
of
general
questions
about
some
of
the
dynamics
that
you're
working
with,
and
the
information
that
you
have
that
led
to
this
policy
decision
and
the
first
one
is,
if
you
could
kind
of
distill
this
for
me,
am
I
a
correction
understanding
that,
in
the
vast
majority
of
cases
or
in
the
cases
that
we
know
of
what
we're
looking
at
for
the
telehealth
services
are
people
are
utilizing
telehealth
instead
of
foregoing
treatment
entirely
as
opposed
to
people
are
using
telehealth
instead
of
going
in
person
like
the
alternative,
was
either
not
go
at
all
or
use
telehealth.
D
Sheriff
asked
for
the
record.
Thank
you,
senator
scheible,
for
the
question,
though
yeah,
especially
during
the
lockdown.
That
was
absolutely
a
choice
since
the
lockdown
was
lifted.
D
This
has
become
a
choice
issue
for
many
because
of
their
own
fears.
Obviously,
unfortunately,
kovid
didn't
do
a
whole
lot
to
improve
the
mental
health
status
of
many
residents
of
the
state.
There's
a
lot
of
fear,
there's
there's
you
know
for
obvious
reasons:
they
may
have
relatives
living
with
them,
who
are
vulnerable
and
do
not
feel
comfortable
going
into
a
another
another
setting
outside
of
their
home.
So
so
in
a
lot
of
ways,
this
has
been
the
fact
that
they
have
not
been
able
to
go
to
the
provider.
D
There
are
providers
who
are
seeing
individuals
in
person
now,
but
that
doesn't
mean
that
all
of
the
consumers
that
they
see
regularly
are
willing
or
able
to
be
them
in
person.
So,
yes,.
D
D
I
it
also
does
not
mandate
that
the
that
the
consumer
has
to
use
telehealth
or
that
the
provider
can
only
use
telehealth.
So
I
think
that's
an
important
point
to
make.
L
And
share,
if
I
may
know
what
I
said
I
don't
have
to,
but
I
just
want
to
put
a
little
bit
of
a
finer
point
on
this,
which
is
to
say
that
if
we
do
want
to
encourage
people
to
go
see
their
providers
in
person
when
possible,
where
possible,
this
policy
would
help
to
do
that
by
removing
a
financial
incentive
to
switch
to
telehealth,
because
it
is
no
longer,
it
would
no
longer
be
cheaper
to
do
it
by
phone
or
by
video.
Instead
of
having
somebody
come
into
the
office.
M
Thank
you,
madam
chair.
I
I
don't
know
if
I've
got
questions
that
can
be
answered,
but
I
I'm
just
going
to
put
them
out.
I
enjoyed
senator
lange
using
her
arms
and
showing
you
know,
emotion,
I'm
interested
in
group
therapy
sessions
how
those
work
I
I
think
that
the
role
of
telehealth
may
be
more
of
augmentation,
of
or
facetime
or
something
in
augmentation
of
in-person
things.
M
You
know
when
we
look
at
the
verbiage
of
standard
telephone
to
the
same
extent,
I
know-
and
I
think
everybody
else
knows
that
if
you
use
a
telephone,
it's
not
the
same.
So
when
I
stop
my
video,
you
see
my
name,
but
you
don't
see.
You
know
anything
else
that
I'm
doing
so
it.
It
helps
to
see
somebody
when
you're
doing
quote
telehealth
or
telemedicine.
M
So
there
are.
There
are
things
that
are
visual
that
are
hard
to
replace
with
anything
else
and
when
we
zoom
we,
we
take
advantage
of
seeing
somebody
eye
to
eye,
as
it
were,
I'm
looking
at
physicians
and
social
workers
and
psychologists
and
therapists
and
family
and
marriage
therapists,
for
instance,
and
when
you're,
when
you're
dealing
with
a
couple's
therapy
you're
interested
in
how
they
both
look
as
opposed
to
a
standard
telephone
workman's
comp
when
you're
looking
at
post-traumatic
stress
disorder.
How
does
workman's
comp
fit
into
this?
The
licensing
and
certification?
M
So
I'm
not
sure
I
can
get
the
right
answer,
but
I
think
the
intent
is
to
extend
telehealth
and
I
would
call
it
telehealth
instead
of
telling
a
telephone,
because
I
don't
think
telephone
is
as
applicable
to
the
quality
as
it
is
telehealth
with
some
visual
contact
or
in
person,
and
that
and
quite
frankly,
from
a
doctor's
standpoint,
it's
hard
to
do
away
with
the
the
impression
of
touch
and
that's
one
of
the
things
that
we
recognize
in
this
pandemic
is
touch.
M
M
D
Senator
hardy
for
the
record,
I
don't
think
that
we
are
in
any
way
trying
to
suggest
that
telehealth
is
equal.
We
know
that
there
are
some
modalities
that
cannot
be
accomplished
or
probably
should
not
be
tried
via
telehealth.
However,
I
think
the
same
can
be
said
for
physical
health,
although
I
can
see
my
provider
via
telehealth
you're,
absolutely
correct.
D
So
I
I
and
just
like
the
provider
of
your
physical
health,
when
you
are
seeing
them
via
telehealth,
they
may
decide
that
they
need
to
see
you
in
person
because
whatever
you're
contacting
them
for
they,
they,
you
know
they
can't
treat
via
telehealth
for
whatever
reason,
but
we
also
want
to
give
mental
health
providers
that
same
latitude
to
work
with
their
individual
patients
and
and
for
the
patient
to
have
a
voice
in
how
their
treatment
is
provided.
D
Especially,
you
know
we
have
seen
some
incredible
things
happen
during
this
pandemic.
D
I
don't
think
that
any
of
us
ever
anticipated
providing
mobile
crisis
services
through
telehealth,
but
yet
there
we
were
so.
We
know
that
it's
not
optimal,
but
we
also
know
that
we
need
to
give
the
consumers
choices
for
how
they
receive
services
and,
unfortunately,
prepare
for
a
future
where,
unfortunately,
this
may,
this
type
of
situation
may
happen
again
whether
it's
a
pandemic,
a
natural.
D
So
this
is
really
in
preparation
for
the
future
and
what
the
future
may
hold
and
if
it
doesn't
hold
that
well,
then
at
least
we've
got
it
in
place
and
people
are
able
to
receive
services,
and
we
certainly
don't
want
to
create
barriers
where
there
doesn't
need
to
be
any.
M
This
just
allows
somebody
to
be
fit
paid
for
it,
which
is
great
for
everybody,
but
you
know:
we've
been
talking
to
people
all
the
time
and
what
this
bill
basically
does
is
it
allows
somebody
to
be
paid
for
it,
which
is
a
huge
opportunity,
because
it
will
incentivize
people
to
do
more
of
it
by
doing
more
of
it,
maybe
we're
incentivizing
people
to
do
less
of
the
person
to
person.
M
I
I
think
it's
a
conundrum,
the
balance
that
we
need
to
do
as
far
as
you
know
what
works
best
for
the
person
as
a
physician,
sometimes
I
say
no,
I
need
to
see
you
and
they
say.
Well,
I
don't
want
to
I
say:
well,
you
know
I
need
to
so
with
telehealth,
sometimes
you're
going
to
get
in
the
quandary
of
you
know.
M
I
need
to
talk
to
you
face
to
face,
and
they
say
well,
I
I
don't
want
to,
and
the
therapist
knows
that
the
best
thing
to
do
is
see
the
person
in
in
real
life
and-
and
we
sometimes
sell
ourselves
short
when
we're
not
seeing
the
person
in
their
natural
habitat
of
how
are
they
dressed?
How
are
they
you
know
what's
their
dem,
so
I
I
think
this
is
great.
I
love
the
concept
of
getting
more
of
telehealth.
M
I
I
love
the
fact
that
we
can
get
paid
for
doing
something
that
we've
always
done,
but
a
standard
telephone.
It
falls
far
short
of
the
real
thing,
but
thank
you
for
bringing
it.
I
don't
want
to
rain
on
this
parade.
However,
thank
you,
madam
chair.
A
So
I
I
just,
I
guess
my
first
question
is,
and
if
you
just
give
me
time
to
finish
this,
my
first
question
would
be:
is
anyone
else
doing
this
other
than
the
va,
and
I
will
read
from
you
from
the
veterans
administration,
page
u.s
department
of
veterans
affairs
is
leading
the
way
in
telehealth
innovation
to
make
sure
veterans
can
access
care
when
and
where
they
need
it.
A
So
I
know
that
during
the
pandemic
the
va
hospital
was
closed.
No
one
was
going
in
and
everything
moved
online
and
I
would
like
to
think
that.
Well,
I
believe
I
got
the
same
quality
of
care
during
that
period
of
time.
So
here's
a
question:
is
it
possible
to
check
with
some
people
who
are
already
doing
it
and
perhaps
the
va
doing
it
right
that
that
may
help?
You
know
make
this
bill
better.
A
I
don't
know,
but
if
there
is
a
way
to
do
that,
then
I
would
encourage
you
to
do
so.
The
last
thing
I
would
say
is
if
this
is
not
replacing
but
augmenting,
is
it
replacing
or
augmenting?
Let
me
just
ask
the
question.
D
A
So
and
I'll
just
I'll
just
make
this
point
and
just
be
like
my
last
point,
I
do
know
that
in
situations
where
some
of
our
troops
are
in
combat
situations,
telehealth
is
probably
the
only
way
that
they
can
get
there.
I
saw
it.
I
saw
it
used
when
I
was
at
the
pentagon
before
a
lot
of
people
were
even
talking
about
it.
A
So
I
would,
I
would
just
say,
check
with
the
va,
because
you
know
I
don't
know
how
many
millions
of
veterans
there
there
are
and
and
many
of
the
veterans
have
ptsd
so
check
with
them,
see
how
they
do
it
see
how
that
what
whatever
the
back
stops
are
to
make
sure
that
it's
ethical
and
make
sure
that
the
patient
doesn't
suffer
and
if
it's
an
augment
augmentation.
A
That
means
that
the
other
piece
is
always
available
check
with
the
va
and
see
how
they're
doing
this,
and
if
you
could
just
let
us
know
as
soon
as
possible.
Okay,
I
see
several
ceremonies.
Your
hand
is
up.
E
Thank
you,
madam
chair.
I
myself,
my
daughters
have
both
used
telemedicine.
You
know
during
this
pandemic
availability.
You
know
they
shut
down
some
of
the
traditional
places
in
order
to
pull
those
health
care,
individuals
in
and
so
I'm
very
supportive
of
the
bill.
E
E
I
found
six
places
that
actually
allow
that
do
text
mental
health
therapy
and
then,
if
somebody
could
also
give
me
the
details,
how
does
that
filled
out?
Because
I
can't
imagine
that
you
text
back
and
forth
at
three
o'clock
for
an
hour
with
the
therapist
versus
going
into
their
office
and
talking
to
them
or
how
does
that
work?
Will
this
also
cover
that
or
how
I'm
a
little
confused
on
that.
D
Thank
you
for
the
question
senator
sotomayer
shar
frost
for
the
record.
That
was
not
the
intent
that
perhaps
mr
keane
would
would
be
able
to
to
answer
that
and
I'm
willing
to
obviously
work
on
that
issue,
because
I
I
don't
know
that
that
was
what
we
had
envisioned
for
this.
And
when
we
were
talking
about
telehealth,
we
were
really
the
board
really
felt
that
it
was
this
kind
of
zoom
environment
or
on
the
telephone
when
zoom
wasn't
zoom
or
whatever
other
platform.
D
I
want
to
call
out
any
single
platform,
but
we
wanted
to
make
sure
that,
if,
for
whatever
reason,
whether
it
was
lack
of
internet
access,
which
would
be
the
primary
reason,
we
understand
that
this
type
of
situation
that
we're
all
in
this
morning
would
be
better
than
telephone.
We're
not
denying
that.
But
there
are
certain
circumstances.
D
When
I
drove,
I
did
a
tour
of
the
rural
region
march
right
or
last
february
february,
2020
march
2020,
the
end
of
february,
beginning
of
march
and
driving
through
many
of
those
areas
and
talking
to
the
to
people
who
live
in
different
towns
and
communities
across
nevada
was
very
telling
to
me
about
the
kinds
of
issues
that
they
face
with
unstable
internet.
We
just
don't
have
that
infrastructure
in
place.
We
all
know
we
need
it.
It's
a
budgetary
issue.
D
I
think
primarily
logistically
it's
going
to
be
difficult,
but
we
just
wanted
to
make
sure
that
people
had
the
ability
to
access
services
so
that
that
individual
who's
living
200
miles
away
or
100
miles
away
from
the
news
provider.
D
I'm
not
none
of
us
are
saying
that
they
would
be
in
a
telehealth
platform
every
single
time.
We're
saying
that
we
want
them
to
have
the
ability
to
access
those
services,
regardless
of
whether
they're
rural,
regardless
of
whether
they're
urban.
But
if
there
is
a
legitimate
reason,
they
can't
access
some
sort
of
video
teleconferencing
platform
that
they
do
have
the
ability
to
access
regardless.
J
Sheriff
spearman,
with
your
permission,
may
I
clarify.
A
J
J
There
are
provisions
that
are
already
in
nrs,
which
already
authorize
telehealth
for
for
services
in
general
that
are
provided
by
an
insurer
and
and
telehealth
itself.
The
word
baby
is
misleading.
Telehealth
requires
audio
and
visual.
So
under
the
existing
law
you
have
to
provide
behavioral
health
services
or
any
other
services
through
telehealth,
but
only
if
it's
audio
and
visual
and
the
nuance
that
this
bill
is
providing
for.
J
Among
other
things,
is
to
allow
behavioral
health
services,
it
carves
out
behavioral
health
services
from
the
other
health
care
services
and
says
for
behavioral
health
services.
You
can
provide
those
by
standard
telephone,
in
other
words
audio
only
which
would
nor
which,
under
current
while
you
can't
do
you
have
to
have
audio
and
visual
under
this
bill
for
behavioral
health
services,
only
you
could
provide
could
provide
the
service
through
audio
only
and
and
that's
what
the
bill's
meaning
to
do.
J
I
would
not
read
this
bill
to
allow
for
texting
without
audio,
and
there
was
another
question
that
came
up
earlier
with
regard
to
other
states.
J
A
Thank
you,
okay.
So
if
there
are
no
additional
questions
from
committee
members,
let
us
move
to
those
who
are
testifying
in
support
and
we'll
go
with
20
minutes
for
support.
20
minutes
for
opposition
and
24
neutral,
and
please
remember
if
whatever
you
wanted
to
say
has
already
been
said.
Please
do
ditto,
so
someone
else
other
people
can
have
an
opportunity
to
speak.
Okay.
A
So
now,
let's,
let's
go
to
the
phones.
B
N
Good
morning,
madam
chair
members
of
the
committee,
stephen
cohen,
for
the
record
I'll,
keep
it
nice
and
brief
ditto
everything
that
the
presenters
have
said.
Additional
remarks
that
provide
some
context
will
be
provided
to
the
committee
manager.
Afterwards,
with
that,
madam
chair,
thank
you.
I
yield.
B
O
J-A-C-Q-U-E-L-I-N-E
h-a-r-r-I-s,
thank
you
for
this
opportunity
to
speak
in
support
of
sb
56.
I
am
a
licensed
marriage
and
family
therapist
and
licensed
alcohol
and
drug
counselor
in
private
practice
at
creative
solutions
counseling
center.
I
am
also
a
member
of
the
clark
regional
behavioral
health
policy
board
and
a
member
of
the
clark
county
children's
mental
health
consortia.
O
Last
march,
due
to
the
covid19
pandemic,
my
colleagues
and
I
switched
entirely
from
an
in-person
practice
to
telehealth
within
a
number
of
days.
I
was
completely
telehealth
for
10
weeks
and
am
currently
a
hybrid
of
in-person
and
tele-health
based
on
client
need
and
preference
as
a
private
provider
of
behavioral
health.
There
are
several
reasons
I
support
this
bill.
O
First,
the
bill
would
allow
for
ongoing
flexibility
of
service
delivery.
This
would
allow
seamless
provision
of
any
person
in
telehealth
as
needed
or
requested
by
the
client.
I
also
support
this
bill
for
continuity
of
care.
It
allows
for
clients
to
stay
with
their
same
provider
versus
switching
to
a
new
provider
under
some
insurance
policies.
If
a
client
wants
telehealth,
they
need
to
end
services
with
their
in-person
provider,
switch
over
to
the
telehealth
option
and
then
continue
with
their
in-person
provider.
If
they
would
like
to.
I
also
support
sb
56
due
to
enhanced
access
of
care.
O
It
allows
for
people
who
have
transportation,
child
care
or
health
care
issues
to
access
services.
Video
teletherapy,
having
a
telephonic
accessibility,
is
also
vital.
Telephonic
access
is
important
for
clients
who
may
not
have
access
to
or
the
technological
skills
to
access
video
sessions.
Also,
in
the
event
that
video
technology
fails
believe
me,
we've
all
been
there.
Treatment
can
go.
C
O
O
B
B
C
C
Telehealth
and
telephone
does
have
unique
costs
that
are
very
different
above
brick
and
mortar
and
I'm
not
sure
they
are
are
less
expensive
or
more
expensive.
I'd
like
to
also
address
the
fact
that
there
are
geographic
differences
in
services
amongst
the
state
fee
for
services
and
managed
care
organization
is
different.
C
What
you
get
in
las
vegas
versus
fernley,
and
I
would
also
like
to
remind
everyone
that
parity
is
still
a
problem,
while
it's
still
a
law
federally,
there
are
a
ton
of
exemptions
to
that
law,
and
and
government
providers
do
not
have
to
follow
the
party
law
and
parity
is
different
unless
you
know
how
to
complain
about
it.
The
fact
is,
you
know
we
enforce
priority
in
the
state
by
complaining
to
the
insurance.
C
Commissioner,
we
don't
proactively,
have
insurance
companies
show
that
they're
providing
purity
for
behavioral
health
conditions
and,
in
fact,
from
the
neck
up,
there's
a
lot
more
barriers
for
people
who
live
with
mental
health
conditions,
but
again
support
this
bill
very
enthusiastically
and
appreciate
all
the
comments
that
have
been
gone
on.
B
H
H
H
H
H
H
Ndpca
believes
that
sc
56
is
an
excellent
beginning
to
the
to
the
discussion
of
adding
audio
only
telehealth
to
the
current
definition
of
telehealth
and
nrs.
The
committee
should
approve
this
bill.
We
also
believe
this
bill
does
not
go
far
enough
to
expand
primary
care
services
allowed
to
audio
only
telehealth.
H
H
B
O
It
adds
adding
telephonic
means
adds
a
great
benefit
to
our
seniors
and
some
of
our
lower
income
residents
in
rural
areas
that
don't
have
access
to
smartphones
or
ipads,
and
for
those
that
have
limited
bandwidth.
This
expands
access
to
behavioral
health
services
to
nevadans
that
have
difficulty
with
distance
transportation
or
in
the
rural
areas.
O
People
is
very
difficult
not
being
able
to
see
those
visual
cues
that
we
get
from
assessing
patients
is
difficult,
but
we
believe
that
in
this
behavioral
health
arena-
and
in
these
times,
excuse
me
this
is
better
than
not
having
access
to
these
services
at
all.
We
support
this
bill
and
hope
that
you
will
vote
to
pass
it.
Thank
you.
B
B
B
B
C
My
name
is
adrian
michaelson
a-d-r-I-e-n-n-e-m-I-c-h-e-l-s-o-n,
I'm
resident
of
center
district,
nine,
I'm
in
support
of
the
bill,
primarily
just
because,
even
though
this
impacts
particularly
communities
in
the
rurals
and
also
out
not
in
urbanized
areas.
As
someone
who
lives
in
las
vegas,
I
recently
had
to
use
a
telehealth
specifically
for
my
physical
health
to
find
out
that
I
had
cancer.
C
So
for
me
I
recently
had
a
emergency
surgery
prompted
by
a
telehealth
appointment
with
my
physician,
and
I
needed
that
telehealth
appointment
specifically
because
I
was
unable
to
physically
go
to
visit
my
physician,
and
that
was
in
the
case
of
being
unable
to
walk
by
myself.
I
had
nephrotic
syndrome.
It
caused
my
ankles
to
puff
up
and
make
it
hard
and
challenging
for
me
to
move
and
able
to
access
healthcare
even
within
minutes
of
my
own
house.
So
in
the
case
of
physical
health,
I
found
using
telehealth
services
incredibly
important
and
consequential
for
my
health.
C
So
it's
no
different
than
the
case
for
people
who
even
don't
have
access
within
a
couple
miles
to
access
quality
and
well-known
mental
and
health
and
physical
health
care
that
they
should
at
least
have
the
opportunities
to
be
able
to
access.
You
know
quality
care,
even
if
it
is
buy
a
telehealth
appointment.
So
I
stand
and
support
the
bill
and
I
hope
you
guys
consider.
G
C
B
P
Chair
will
chairwoman
spearmen
and
members
of
the
committee
for
the
record.
My
name
is
barry
gold
b-a-r-r-y-g-o-l-d
and
I'm
the
government
relations
director
for
aarp
nevada.
We've
certainly
seen
the
value
of
telehealth
during
the
pandemic.
That's
improved
access
to
medical
care
and
treatment
when
people
have
been
told
to
basically
stay
at
home
as
much
as
possible.
Telehealth
can
be
the
only
option
available
for
medical
appointments
and
services
by
adding
the
use
of
step
standard
telephones.
P
Sb
56
makes
an
important
addition
to
the
availability
and
it
will
help
many
nevada
families.
Many
low-income
nevadans
lack
the
means
to
have
access
to
video
video
and
they
rely
just
on
standard
telephones
and
many
older
nevadans
still
rely
on
that
old
trusty
telephone
that
still
plugs
into
the
wall,
and
they
don't
have
cell
phones
with
video
capability.
P
Family
caregivers
need
help
if
they
are
to
continue
what
they
do
and
telemedicine
is
one
way
to
provide
this
needed
support
so
aarp
on
behalf
of
our
345
000
members
across
the
state
support
sb
56
that
will
improve
the
access
to
health
care
by
increasing
availability
of
telehealth
for
nevada
families,
who
must
and
only
rely
on
standard
telephones.
Thank
you.
A
Thank
you.
So,
let's,
let's
move
to
opposition
and
the
same
rules
apply
20
minutes
and
two
minutes
per
speaker.
B
B
B
Q
Q
We
appreciate
the
legislature's
telehealth
legislation,
both
in
2013
and
2015.
That's
afforded
the
ability
for
innovation
within
the
health
care
services,
as
we
continue
to
face
the
covenant,
19
pandemic,
making
sure
individuals
and
families
can
access
care
when
needed.
If
that's
a
priority
for
all
of
us,
telehealth
options
allow
you
to
do
so
safely
securely
and
conveniently
from
your
own
home.
Q
We
do,
however,
have
concerns
with
provisions,
including
the
use
of
audio
only
in
behavioral
health
with
audio
only
a
telephone.
The
clinician
is
unable
to
appropriately
assess
the
patient
in
ways
that
two-way
live.
Video
can
provide,
such
as
body,
language
surrounding
environment
and
facial
expressions.
Q
The
association
is
in
line
with
the
association
of
behavioral
health
and
wellness
and
their
suggestion
to
seek
input
from
the
appropriate
regulatory
agencies
to
conduct
research
as
to
whether
or
not
behavioral
health
services
provided
via
audio
only
are
an
effective
long-term
strategy
to
provide
safe
quality,
evidence-based
and
clinically
appropriate
care.
Currently,
it's
unclear
whether
audio
only
is
an
appropriate
way
of
providing
service
for
all
behavioral
health
treatments.
Q
We
also
recommend
that
insurers
continue
to
have
the
flexibility
to
negotiate
prices
to
keep
health
care
coverage
affordable
for
all
consumers.
The
payment
parity
provision
is
contradictory
to
help
to
telehealth's
cost
effectiveness.
If
telehealth
can
help
reduce
costs
of
using
the
health
care
system
and
produce
provider
visits,
it's
contradictory
to
mandate,
those
services
be
paid
the
same.
Q
Finally,
we
appreciate
the
flexibility
and
site
location
for
a
patient
to
access
care,
but
we
do
have
a
concern
and
a
question
with
the
quote:
geographic
location,
language
found
in
section
one
sub
four:
is
that
intended
to
extend
beyond
state
lines?
If
so,
we
recommend
language
clarifying
the
provider
is
permitted.
Q
A
Mr
clark,
mr
clark,
hello,
hello,
mr
clark
time
is
up.
If
you
will
submit
the
rest
of
your
testimony,
I
certainly
would
appreciate
it.
We
have
two
minutes
per
speaker.
B
N
Good
morning,
madam
chair
members
of
the
committee,
this
is
marcus
conklin,
m-a-r-c-u-s
c-o-n-k-l-I-n,
with
strategies
360
representing
teledoc
this
afternoon
I
believe,
miss
claudia
tucker
is
already
on
the
line,
so
I
was
just
kind
of
holding
space,
but
you
have
the
written
testimony
and
I'm
sure
she's
here,
to
provide
any
additional
any
additional
testimony
and
support
on
our
position
and
I'd
yield.
The
rest
of
my
time
manager.
B
A
Hey,
thank
you
so
we'll
move
to
the
to
the
neutral
now,
and
let
me
say
I
I'd
like
to
start
this
off.
We
have
someone
here
that
can
address
the
fiscal
note.
Is
that
correct
mr
memory,
health.
K
Good
morning,
madam
chair
and
committee,
my
name
is
dwayne
young.
I
am
the
deputy
administrator
for
the
division
of
healthcare,
financing
and
policy
for
the
record.
Thank
you
for
allowing
me
to
be
here
today
to
present
our
testimony
on
our
fiscal
note.
This
bill
does
have
approximate
fiscal
note
of
32
million
dollars
in
state
general
fund
and
a
half
million
dollars
in
county
match
funds
per
federal
cfr.
K
410.78
telehealth
services
require
audio
and
video
equipment
with
interaction
community
telecommunications.
This
was
waived
during
the
public
health
emergency.
However,
the
office
of
civil
rights
within
the
department
of
justice
has
authority
over
the
cfr
and
would
have
to
take
federal
action
in
order
to
remove
this
provision
requiring
audio
visual
within
telehealth
component
outside
of
the
public
health
emergency,
and
so
that
is
the
demonstrated
fiscal
impact
of
this
bill,
meaning
that
the
if
that
federal
regulation
was
not
raped
after
the
state.
K
After
the
declaration
of
the
public
emergency
ends,
the
state
would
be
responsible
for
both
the
state
share
and
the
federal
share
of
any
of
these
services
that
were
provided
through
a
non-hipaa
compliant
platform.
It
also
has
other
implications
throughout
policy.
K
In
regards
to
cost-based
reimbursed
providers
and
the
cost
methodology
is
built
built
on
their
infrastructure,
and
so
those
that
are
providing
mostly
in-person
services
would
have
a
higher
methodology,
while
those
providing
telephonic
services
would
definitely
have
a
lower
cost
based
in
built
into
their
methodology,
and
so
this
would
tie
the
division's
hands
to
appropriately
assess
those
costs
for
those
cost
based
reimburse
providers.
B
H
B
N
Madam
chair,
I
have
a
caller
on
the
line
in
opposition,
but
for
some
reason
it's
not
she's
not
being
able
to
enter
the
queue
and
I'd
like
for
her
to
have
the
opportunity
to
testify,
and
I
just
don't
there's
no
way
for
me
to
connect.
I
could
get
some
help.
M
Broadcast
this
says
the
merger
who
her
last
two
digits
are
716.
B
B
B
A
So
I'm
wondering
if
we
can
connect
to
that
person
through
mr
conklin,
since
he
was
able
to
get
through.
B
B
I
will
work
it
out
with
the
staff
online
to
see
if
we
can
get
the
caller
on
the
phone,
and
I
will
let
you
know.
Thank
you.
A
B
Yet
no
chair,
okay,.
A
A
F
He
says
that
he's
on
the
line,
mr
conklin,
but
I
don't
know
what's
happening.
He
has.
N
Thank
you,
madam
chair.
It's
marcus,
conklin,
again
I'll
spare
the
spelling
the
third
time
we
have
submitted.
We
have
submitted
written
testimony.
Madam
chair.
Our
issue
is,
we
are
supportive
of
what
this
bill
is
trying
to
accomplish
in
terms
of
being
able
to
treat
mental
health
patients
using
more
traditional
telephone
methodologies.
N
It
appears
in
the
written
language,
however,
that
in
an
effort
to
find
payment,
parity
for
bricks
and
mortar
doctors,
it
seems
to
sweep
in
traditional
telehealth
organizations
as
well.
Those
are
those
that
that
provide
exclusively
telehealth
services,
and
we
have
talked
with
miss
frost
and
chair
about
our
concerns.
N
We
did
provide
some
suggested
language
to
amend
that
to
allow
bricks
and
mortar
doctors
to
have
payment
parity
when
they
choose
when
it's
right
when
they
choose
to
treat
their
patients
via
telehealth,
but
also
to
allow
the
market
to
determine
rates
on
telehealth
services
as
it
pertains
to
those
that
are
exclusively
providing
telehealth.
N
We
are
not
wedded
necessarily
to
the
exact
language
that
we
wrote.
We
are
willing
to
work
with
the
sponsor
and
the
committee
to
find
language,
that's
right
and
works
for
nevada
and
allows
both
services
to
go
forward
in
a
way,
that's
healthy
for
the
marketplace
and
conducive
to
patients
and
doctors
and
madam
chair,
I
I
don't
know
how
I
might
be
able
to
get
a
miss
tucker
on
the
line
to
provide
additional
testimony.
C
A
C
C
A
C
I'm
senior
vice
president
of
government
affairs
and
public
policy
at
teledoc
health.
I
just
want
to
say
that
the
physician
shortage
is
real.
The
shortage
of
mental
health
providers
is
even
more
critical.
Virtual
care
is
health
care.
Just
as
technology
has
changed
the
way
we
bank
the
way
we
shop
the
way
that
we
travel
and
the
way
that
we
interact
with
others.
Technology
has
changed
the
way
that
we
deliver
health
care
and
the
way
that
we
receive
health
care
senate
bill.
56
has
some
very,
very
good
policy
points.
It
doesn't
require.
C
Prior
in
person,
it's
technology
neutral.
It
removes
any
geographic
restrictions
and
it
doesn't
require
reason
why
the
patient
has
chosen
telehealth
over
an
in-person
visit,
in
addition
to
increased
access
to
quality
health
care.
Telehealth
also
brings
savings
to
both
the
patient
and
the
payer,
because
this
bill
required
that
a
telehealth
visit
be
reimbursed
at
the
same
rate
as
an
in-person
visit.
These
savings
will
be
removed
and
will
create
an
artificial
financial
arrangement
that
doesn't
exist
today.
Should
a
prior
provider
be
reimbursed
for
behavioral
health
services
offered
through
telehealth?
C
Absolutely
if
a
provider
can
offer
those
services
at
a
lower
amount
should
they
be
forced
to
remove
the
savings?
No,
my
point
is
not
that
bricks
and
mortar
practices
shouldn't
be
reimbursed
at
the
full
amount.
They
have
overhead
they've
got
expenses,
the
telehealth
companies
do
not.
Companies
like
teledot
can
provide
quality
healthcare
and
the
savings,
and
we
currently
do
that
in
nevada.
C
In
2020,
we
were
able
to
save
patients
and
payers
over
24
million
dollars
in
health
care
costs.
This
savings
will
be
removed
as
this
provision
stays
in
the
bill.
We
support
that
the
work
that
the
legislature
is
doing
to
help
increase
access
to
mental
health
treatment,
the
ability
to
use
the
telephone
to
expand
the
reach
of
mental
health
services
to
those
who
need
it
is
critical.
C
We
ask
that
you
also
give
one
more
tool
to
your
residents,
and
that
is
to
please
remove
the
reimbursement,
parity
language
in
this
bill
and
allow
the
savings
that
telehealth
brings
to
remain
available
to
the
residents
of
nevada.
Thank
you
and
I'm
glad
to
answer
any
questions.
Again.
Apologies
for
the
technical
difficulties.
A
While
seeing
none,
we
will
close
the
hearing
on
senate
bill
56
and
I'm
going
to
have
mr
mourinho
reach
out
to
both
sides.
So
we
can
kind
of
figure
out
how
to
get
to
go
on
this.
Okay,
we'll
open
it
up
now
for
public
comment,
public
comment
and
if
there's
anyone
on
the
line,
two
minutes,
two
minutes
per
person.
B
B
A
I
know
that
this
is
is,
although
it's
cognitive,
it
sounds
like
it
may
be.
No
pun
intended
an
emotional
issue
as
well,
so
I'm
going
to
encourage
both
sides
to
get
with
us
and
try
to
see
what
we
can
do.
So
let
me
say
this
as
a
reminder.
A
Anyone
who
would
like
to
provide
public
comment
make
sure
that
you
register
online
at
nellis
on
the
legislative
website
and
after
you
register
you'll,
be
provided
telephonic
information
to
participate.
A
So
I
said
this
in
our
last
meeting.
I
just
want
to
say
it
again
for
those
who
may
not
who
are
on
the
line,
who
may
not
have
heard
we
are
participating
virtually
so
that
we
make
sure
that
people
are
safe
and
make
sure
that
we
do
not
contribute
to
the
more
the
infection
rate
of
covet
19..
A
I've
heard
from
several
people-
and
this
is
probably
better
for
many
people
who
don't
have
transportation
or
who
work,
who
work
during
the
day
and
would
not
be
able
to
take
off
work
to
get
to
grants
lawyer
or
take
off
time
to
come
to
the
legislative
building.
So
I
would
just
encourage
everyone.
A
Please
utilize
this
this
option,
it's
there
for
you,
so
that
we
may
be
able
to
meet
your
needs,
and
so
having
said
that,
if
we've
said
and
done
everything
we
need
to
do,
then
our
meeting
will
be
adjourned
until
nine
o'clock
on
wednesday.
Thank
you.